COLUMN ONE

Big C in the course work

A USC student never expected to study medicine by getting cancer. His blog gives other aspiring doctors plenty to think about.

6 a.m. June 26, 2007: I open my eyes to at least 15 faces within three feet of mine, staring at me expectantly. Everyone is calling my name. I find it frankly amusing. What's up, everyone? Hi! Why are you asking ME what's going on? I have no idea! And can I please go back to sleep? Yes, I know where I am, yes, I know my name, hi mom, why are you crying?

Joshua Lilienstein was supposed to be one of the people in the white coats, not the guy in the hospital gown. A near-death experience was not how he had intended to study medicine.

Back in April of 2006, Lilienstein was 26 and a month away from completing his first year at USC's Keck School of Medicine. Then he discovered a hard, irregular-shaped bump in his right testicle. What followed would both test him and teach him to be a doctor.

The resident on duty that day in the family medicine clinic diagnosed MSD -- Medical Students' Disease, a particularly virulent form of hypochondria. Undeterred, Lilienstein sought out a radiologist, whose own hypochondriac jokes sputtered to a stop when the ultrasound confirmed a tumor.

Within a week, Lilienstein underwent surgery at the USC/Norris Comprehensive Cancer Center to remove the cancerous testicle. Immediately after his final exams in early June, he had a second surgery at a San Francisco hospital to take out the lymph nodes behind the major organs in his abdomen.

For the next five months, he said, everything -- except for having cancer in the first place -- was "peachy." Testicular cancer is, after all, highly curable when caught early, as his was.

By November of his second year of medical school, he was feeling so optimistic that he almost convinced himself that it was perfectly normal to develop a beer belly in just a few weeks. Then, at a six-month post-surgery checkup at USC/Norris, a CT scan detected tumors -- lots of them -- in his abdomen.

"And blammo," he recounted in the first entry of the blog he began that month. "Suddenly everything, everything, everything, is up in the air."

Day 1. Monday Nov. 13, 2006:[The cancer's spread] places me in a not-too-euphemistically named "poor" prognosis category. The outcome for this group is maybe not much better than flipping a coin ...

EVEN in a class of 170 idealistic and committed medical students, Josh Lilienstein stood out.

As one of the few to enroll in a dual program leading to both a medical degree and a doctorate, he combined a doctor's humanitarian wish to help others with a scientist's analytic curiosity.

"He's just naturally inclined to ask questions about what's going on and why is this happening and what does this mean," said Dr. Peter Katsufrakis, the outgoing dean of students at USC's medical school.

The blog, www.jlilienstein.blogspot.com, said Katsufrakis, forced the aspiring physicians to think about whether they were ready for a career that would inevitably involve death and loss.

Judging from the comments, the blog prompted such reflections from an even wider circle of readers: "I want what you've got," wrote a longtime family friend. "Not the cancer, just the attitude."

In the meantime, Lilienstein took a medical leave from his studies.

He bypassed the standard chemotherapy treatment and opted for an experimental regimen that used higher doses of drugs over a longer period of time. He recalled his father saying, "We've gotta hit this thing hard, hit it out of the goddamn park."

For the next 16 weeks, he would check into USC/Norris on a Monday to begin five days of what he called "life-giving poison." He would check out on Friday and spend the next few days recovering at the Los Feliz apartment he shared with his girlfriend. Then he would check in for another five days of poison.

The drugs left him tired, then jittery, then tired again. One sentence on his blog -- "Must force myself to be social" -- spoke volumes about a man his own mother described as a party animal.

Nov. 23: i get told a lot that this experience will one day make me a better doctor, and i am even starting to believe it. all of a sudden i feel a lot of sympathy for old people. the similarities are stunning: constant dependence on others; discomfort that will not go away; feeling like there are things that i used to do that are no longer possible, that who i was no longer exists ...

BY mid-December, Lilienstein's belly was shrinking and his tumor markers were falling, signs that the chemotherapy was working.

Still, the intensive treatment continued. The plan remained to "knock it out of the park," even as cistoplatin -- the miracle drug that in 1973 transformed advanced testicular cancer from a death sentence to survivable -- attacked healthy cells along with the cancer cells.

Losing his hair was the least of it. His hands tingled. His ears screamed. He spent whole afternoons retching.